In this episode, Dr. Melody Rodarte joins the show to discuss the critical role hormones play in weight loss, particularly for women aged 35 to 65. The conversation delves into the misconceptions surrounding hormone replacement therapy and the benefits of using hormones appropriately to support health and well-being.

Key Topics You'll Discover with Dr. Melody Rodarte

🔑 KEY DISCUSSIONS:
① Introduction to Hormones and Weight Loss:
👉 Dr. Melody shares her background in obesity medicine and her journey into hormone therapy.
👉 The episode focuses on the relevance of hormone management for weight loss, especially for women experiencing hormonal changes.

② Misinterpretations of Hormonal Data:
👉 Discussion on the false interpretations of data from past studies that instilled fear about hormone use.
👉 Dr. Melody emphasizes the need to re-educate women on the benefits of hormone replacement therapy.

③ Benefits of Hormone Replacement Therapy:
👉 Hormone therapy can reduce risks of brain, bone, and heart issues, and even breast cancer in some cases.
👉 The importance of using hormones in a healthy, supportive way.

④ Current Landscape of Obesity Medicine:
👉 The evolution of tools and medications available for obesity management over the last few years.
👉 Introduction to anti-obesity medications like Semaglutide and Tirzepatide.

⑤ Microdosing and Personalized Care:
👉 Dr. Melody discusses the benefits of microdosing hormones and the personalized approach to hormone therapy.
👉 The importance of individualized treatment plans based on patient history and current health status.

⑥ Practical Advice for Patients:
👉 Recommendations for patients to seek out practitioners who listen and provide personalized care.
👉 Encouragement for patients to be proactive in their health management.

What You’ll Take Away from Dr. Melody Rodarte

📌 Hormones play a significant role in weight management and overall health, especially for women in midlife.
📌 Misinterpretations of past studies have led to unnecessary fear about hormone therapy.
📌 Personalized and informed hormone therapy can offer numerous health benefits.

Dr. Melody Rodarte

Dr. Melody Medawar Rodarte has been a distinguished double-boarded specialist in Internal and Obesity Medicine, serving as a cornerstone of comprehensive healthcare in Arizona since 2006. Her educational journey, encompassing undergraduate studies, medical school, and residency, unfolded right here in Arizona.

Beyond her advanced certifications in Hormone Replacement, Hyperbaric Medicine, Wound Care, and Medical Aesthetics, Dr. Rodarte’s holistic approach to wellness sets her apart. She has been named a PHOENIX Magazine “Top Doc” in Obesity Medicine for seven years.

Motivated by personal experiences with family illness, Dr. Rodarte is devoted to treating the whole person.

Dr. Rodarte takes a personalized approach to help patients feel better, look better, and ultimately live better. For her, that approach is centered around a mission to be at the forefront of how medicine should be by offering personalized services and treatment plans for weight loss, internal medicine, hormone replacement, and body contouring.

Beyond her medical practice, Dr. Rodarte, alongside her husband Tony, established The Compassion Alliance: a non-profit that connects first responders and their spouses with free confidential help from mental health professionals when the stress of their job becomes too much.

Dr. Melody Rodarte is a leader in modern medicine, championing a holistic and personalized approach that empowers her patients to not only look and feel better but also live better lives.

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Dr. Jill Carnahan, MD

Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy.

As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs. 

A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.

Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names. 

The Podcast with Dr. Melody Rodarte

The Video with Dr. Melody Rodarte

The Transcript – Overview

Overview

• Dr. Melody Rodarte, double board certified in internal and obesity medicine since 2006, emphasizes the need for comprehensive obesity treatment beyond medication.
• New anti-obesity medications like semaglutide and tirzepatide have transformed the landscape, with 10 FDA-approved options now available.
• Concerns arose regarding the influx of physicians prescribing obesity medications without a full understanding of integrated treatment approaches.
• Microdosing of GLP-1 medications offers a precise starting point for patients, showing positive anti-inflammatory effects beyond weight loss.
• The misinterpretation of data from the Women's Health Initiative in 2001 created unwarranted fears around hormone replacement therapy.
• Balanced exercise, particularly strength and Zone 2 training, is more beneficial than high-intensity workouts for women managing hormonal health.
• Extensive lab assessments, including complete thyroid evaluations and advanced lipid panels, are critical for optimal patient care.
• Early metabolic intervention at A1C levels of 5.4-5.6 is essential to prevent diabetes, focusing on protein intake and lifestyle modifications.
• Starting hormone therapy with progesterone and testosterone rather than estradiol is effective in managing symptoms for perimenopausal women.
• Research indicates potential protective benefits of testosterone therapy for breast cancer survivors when used in conjunction with aromatase inhibitors.

Notes

🎙️ Introduction & Host Background (00:00 – 02:23)

• Dr. Jill hosts Resiliency Radio podcast focusing on integrative and functional medicine
• Promotes curated health products at Dr. Jill health.com, highlighting Needle Free Serum as top seller lasting 3-6 months
• Target audience consists of women aged 35-65 struggling with weight gain and hormonal issues

👩‍⚕️ Dr. Melody Rodarte's Professional Journey (02:23 – 05:14)

• Dr. Melody Rodarte is double board certified in internal medicine and obesity medicine since 2006 in Arizona
• Obtained second board certification in obesity medicine in 2013 after practicing informally for 3-4 years prior
• Trained in osteopathic medicine with allopathic residency, sought additional nutrition training due to inadequate medical school preparation
• Started with bariatric surgery program, providing 3-6 months outpatient follow-up before surgery

📈 Evolution of Obesity Medicine Landscape (05:14 – 11:42)

• Significant changes in obesity medicine over last 5-6 years with introduction of new medications
• 10 anti-obesity medications currently available on market, with semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound) being game-changers
• Phentermine remains valuable medication since 1959, prescribed frequently with no withdrawal or addiction issues
• Concern about physicians entering field solely to prescribe medications without proper understanding of comprehensive approach

💊 GLP-1 Medications and Microdosing Approach (11:42 – 17:27)

• Microdosing strategy allows starting at 0.07-0.01mg instead of standard 0.25mg semaglutide starting dose
• Compounded versions preferred for past 2-3 years for precise dosing and quality control
• Anti-inflammatory benefits observed beyond weight loss, including improved brain function and joint pain reduction
• Research shows reduction in cytokines and inflammatory markers like interleukins and TNF

🧪 Hormone Replacement Therapy Foundation (06:33 – 10:17)

• Women's Health Initiative (2001) created unfounded fear of hormones through misinterpretation of data
• ‘Estrogen Matters' by breast oncologist recommended as essential reading for patients
• Synthetic progestin arm showed increased breast cancer risk, while estrogen-only arm showed decreased Alzheimer's, cardiovascular disease, and breast cancer
• International medical communities more progressive in hormone use, including for breast cancer survivors needing vaginal estrogen

🏋️‍♀️ Exercise and Stress Management (21:19 – 22:36)

• Over-exercising epidemic among professional women, particularly high-intensity workouts driving cortisol elevation
• Dr. Jill's personal transformation at age 40: stopped intense running, adopted walking and weight training, achieved best body composition
• Boot camp elimination recommended by practitioners for patients with no hormonal reserve
• Zone 2 heart rate training and strength training produce superior results compared to high-intensity cardio

📋 Comprehensive Patient Assessment Protocol (25:07 – 28:00)

• One-hour consultations with six-page history forms completed prior to appointment
• Extensive lab panel including complete thyroid panel with antibodies, not just TSH
• Hormone evaluation includes estradiol, progesterone, DHEA, morning cortisol, morning insulin, and A1C
• Advanced lipid panels with genetic markers like APOB, lipoprotein A, and CRP

⚠️ Pre-Diabetes and Metabolic Intervention (26:28 – 30:37)

• Early intervention at A1C levels of 5.4-5.6 rather than waiting for 6.5 diabetic threshold
• Top treatment priorities: reduce simple carbohydrates, eliminate fasting during perimenopause, ensure 1-1.5g protein per kg body weight three times daily
• Lifestyle modifications: remove soda and alcohol temporarily, implement consistent sleep routine
• Medication options: berberine, metformin for PCOS or budget constraints, microdosed GLP-1 agonists

🌸 Perimenopause Hormone Strategy (31:49 – 34:23)

• Initial hormone approach: start with progesterone and testosterone rather than estradiol
• Testosterone benefits: improved endurance, libido, metabolism, and belly fat reduction at smaller doses
• DHEA alternative for patients nervous about testosterone, serving as precursor hormone
• Thyroid optimization: TSH range 0.5-1.5, free T3 above 3.4 for symptomatic patients

🔬 Testosterone and Breast Cancer Research (35:39 – 36:50)

• Historical use: testosterone used to treat breast cancer in 1940s
• Emerging research: new studies using testosterone with aromatase inhibitors to treat DCIS showing promising results
• Protective mechanism: testosterone blocks estrogen receptors, potentially offering protection rather than risk
• Oncologist collaboration: working with cancer specialists to provide testosterone for muscle mass and symptom management in survivors

🧠 Long-term Hormone Therapy (39:26 – 42:29)

• Lifelong hormone use: patients should continue hormones after age 65 contrary to outdated medical advice
• Brain protection: estrogen essential for cognitive function, with some practitioners starting 85-year-olds on estrogen for Alzheimer's prevention
• Receptor maintenance: avoiding hormone gaps prevents receptor shrinkage and maintains therapeutic benefit

Transcript

00:00
Dr. Jill Carnahan
Hey everybody. Welcome to Resiliency Radio, your go to podcast for the most cutting edge insight integrative and functional medicine. I'm your host, Dr. Jill and with each episode we dive into the heart of healing and personal transformation. Join us as we interview thought leaders, medical experts, researchers and all types of interesting people to bring you tips and tricks for optimal performance, longevity and just to live a better life of three thriving in the midst of whatever you're facing. Today's no different. We're going to talk about weight loss and hormones, a topic in the minds of many of you, many of the listeners have really enjoyed. I've had some previous episodes. Today is going to be such a treat. You're going to love Dr. Melody Rodarte. 

00:41
Dr. Jill Carnahan
Before I introduce her, let me just remind you can find curated amazing products for your optimal health and performance@doctor Jill health.com that's D R J I L L health.com and I always love to grab one of my favorite products here just to randomly. This one is bestseller often on the market. It is as far as we've run out of it before. It's called Needle Free Serum. This one is kind of a Botox in a bottle for those of you who need a little help around the eyes or under the eyes, a little goes a long way. So this bottle will probably last you three to six months. You just need a couple drops. It's called Needle Free Serum. It is one of our top sellers and you can find it at Dr. Jill health.com okay, let me introduce Dr. Melody. 

01:22
Dr. Jill Carnahan
Dr. Melody Rodarte has been a distinguished double board certified specialist internal medicine and obesity. Medicine served as a cornerstone of comprehensive healthcare in Arizona since 2006. She takes a personalized approach to help patients feel better, look better and ultimately live better. Centered around the forefront of how medicine from mental health and otherwise root cause medicine. She has multiple practitioners in her practice and she brings such a wealth of knowledge in functional integrated medicine and root cause medicine. You will love this interview. So let's get to it. Dr. Melody, I am delighted to have you on the show and it is one of the most popular topics. 

02:02
Dr. Jill Carnahan
You've been doing this well before it was popular but our title today is Hormone for Weight Loss and I think if there's, I don't know if there's any more relevant topic to my audience because it's a lot of women 35 to 65 who are struggling with weight gain and what's going on with my hormones. So guys, if you're listening today, stay tuned I know we're going to go deep and I know we're going to get some great information from Dr. Melody. But before we go there, I always love to know your background as far as how you got into what you're doing. I think you said obesity medicine was one of your backstories. Tell us a little bit about how you got into medicine and then the journey to what you're doing now. 

02:36
Dr. Melody Rodarte
Yeah. First, thank you so much for having me. Any opportunity to promote health and advocate wellness, I love to take. So I follow your podcast. So I'm super excited to be with you today. So thank you for this opportunity. You know, I love. I love wellness. From the very beginning, when I was an internal medicine resident, I noticed that if I could teach my patients how to eat well and take care of their weight, they would age slower. It was such an integral part. And as I started into my first practice, it was more geriatrics. I'm like, this is not for me. I really want to do preventative health. And so after that first year in private practice, I made that switch and to really trying to hone in on. 

03:23
Dr. Melody Rodarte
I think you even mentioned it earlier when were kind of talking like 35 to 65. Is that range where we can do so much? And I noticed that I had more and more opportunities to learn more and more about obesity medicine specifically. So I got my second board Certification in 2013 in obesity medicine after really kind of doing it for three or four years prior to that, but not knowing that there was an actual certification I could go and do. 

03:54
Dr. Jill Carnahan
Yeah, that's something for me too. Obviously, I've met a few doctors who are certified, but I would say as a medical doctor, I didn't really all that's available. What does that training look like? Like, what kinds of areas did you really learn as far as conventionally. Training? 

04:08
Dr. Melody Rodarte
Yeah, so my conventional. So I. I'm a doctor of osteopathic medicine. So we had some nutrition during that time. But I will tell you, not. Not enough. 

04:17
Dr. Jill Carnahan
Right. 

04:19
Dr. Melody Rodarte
And then I did an allopathic residency, so. 

04:22
Dr. Jill Carnahan
And even less. Right. 

04:24
Dr. Melody Rodarte
Yeah. So I had to seek it out so very young because I was really interested in wound care and hyperbaric medicine. I was lucky to start going to some nutrition classes and sitting with some of the nutritionists and figuring that part out and with doing medical aesthetics as well. And so then as I had an opportunity because I was the chair of pharmacy and therapeutics for a major hospital group here, I started learning even more. And they were starting a bariatric program. And they said, okay, can you do the outpatient side of this, where we have to follow them for three to six months before they can have bariatric surgery? So it just became something that I was really honing in on and understanding. And then I had the opportunity to really train under some incredible obesity medicine specialists. 

05:14
Dr. Melody Rodarte
And they said, we'll train you and you can get your board certification. And so I did that. And like, the. The. It's just kind of rolled, you know? And in the beginning, I saw how hormones were important, but I trained in that 2002-2005 E where it was like, yay, hormones. And it was like, no stop at all, right? And I thought, oh, how am I going to help my patients here? Because there's like this black box warning. And so, yeah, it's like. And I think in your. I think I can speak for you as well with following you. It's really important that we follow the importance of where medicine is going and always learn, because if we only took for what we came out of residency with, we're going to behind the eight ball. Medicine is ever changing. 

06:04
Dr. Melody Rodarte
And so I'm thankful that I kept seeking out either functional medicine or integrative medicine courses, because otherwise, if I was just going to the regular courses, I wouldn't be where I'm at right now or being able to really efficiently help my patients. 

06:19
Dr. Jill Carnahan
Okay, so you and I are totally the same as far as the allopathic residency, no nutrition. And then like 2001 when I graduated, then residency up to O3, I think, or after. No, it was actually.03 to 6. So anyway, very similar time frame. And I think many who've listened to me before, we've talked about this. But I want to reiterate when we get out in that time frame, when the Women's Health Initiative 2001, which is the year I graduated, it was so fascinating because. Or actually the year I had breast cancer, I graduated two years later. Anyway, they really put the fear of God in us about hormones, and it was all false interpretation of the data, which you can talk today about. 

06:55
Dr. Jill Carnahan
But I love bringing this information because I'm still shocked as I talk to women about hormone replacement in a very healthy, supportive way and the. The decreased risk of BR issues and bone issues and heart issues and even breast cancer in some cases, which people are. I'm still shocked at how many other doctors tell them, oh, my gosh, why are you on hormones? Right? So maybe let's set the framework with just the power of hormones used appropriately, because you are an expert there. And also, how do we really bring this message to women so that there's not the fear that happened because of that study and because of the data that wasn't even statistically significant. Right. 

07:35
Dr. Melody Rodarte
Yeah. I'm just so excited, really, that the. The writers of the WHI that they started to retract saying, oh, my gosh, I think we are doing harm. And that started 2017, 2018. But again, like so many obgyns especially, and our colleagues are a little bit behind if they're not going to some of the updated courses or really looking at it. So I'm glad that we. There are people like you and I that we are telling our patients, look, there are great books out. Like, one of my favorites is estrogen matters by Dr. Yes. 

08:10
Dr. Jill Carnahan
I have it on my bedside. Like, I love it. And it's written by an oncologist on polished. 

08:14
Dr. Melody Rodarte
I'm like, it's a breast oncologist. So, I mean, he goes through all the literature over the last 20 years or more, 30 years, 40 years, you know, and. And so it's so important that we. We really push them. Looking at that new evidence showing that one, the arm that had the increase in breast cancer, where they were on progestin, it's synthetic progest, completely different than micronized progesterone. And then the estrogen on that continued, they actually have less Alzheimer's, less cardiovascular disease, less breast cancer. Finally, we're talking about it. So I love that you brought it up. And I educate my patients all the time. I'm like, I'm not the only one who's saying this. You really need to do. These are safe places. I give them five or six different books, podcasts, or webinars. I'm like, and then the, oh, what is it? 

09:09
Dr. Melody Rodarte
PBS special came out. And that was so wonderful to see all of that being discussed. 

09:16
Dr. Jill Carnahan
Oh, gosh, I love that so much. And again, because were kind of brainwashed in a way the data wasn't. When we got out of med school, were both in that. Like, were. We were afraid because were basically made to fear it because the data wasn't properly interpreted. But I remember years ago, as a breast cancer survivor, I would still say, gosh, if I had to choose my breast or my brain, I would choose my brain. And then I'm like, now I don't have to choose, right? No, no. 

09:42
Dr. Melody Rodarte
And I love how internationally so much is written about with using hormones. I know several countries, even if you're a breast cancer survival, they want you on vaginal estrogen to reduce your chances of urinary tract infections, to help your pelvic floor function, because they know that importance and everything. So we're unfortunately, the US can be a little bit behind the eight ball there. 

10:04
Dr. Jill Carnahan
Right, Right. Yeah, I couldn't agree more. So let's get so excited about you and any guests that we get to talk about this because women need this information and I'm a big proponent. I know you are. So let's talk about the landscape of obesity medicine. You've been in this a long time and you started in bariatric, which is obviously surgical, and now there's so many more options. But what changes have you seen and along the way, like give us a little bit of the landscape of how people maybe used to have to approach weight loss and now the tools that we have. 

10:34
Dr. Melody Rodarte
Yeah, you know, the landscape has really changed in the last five to six years. But those of us who are trained in obesity medicine, we understand that we have a really big tool belt. There are so many, we call them aoms or anti obesity medications. And so we have about maybe 10 still on the market. But in the last five to six years, they really key, the really key components where most of your listeners will know about is semaglutide, you know, which is Ozempic or Wegovy or Tirzepatide, which is Manjurno or Zepbound. Those two really have changed the landscape tremendously. And you know, it's good for those of us who are trained in this manner to know that we can combine medications, we can reduce medications. 

11:22
Dr. Melody Rodarte
We really understand that it's not one size fits all and we don't have to pigeonhole the patient into one specific medication. And I think that in the last 12 to 13 years I've really seen that where I kind of knew what my starting medications were, you know, it was like phentermine and which is still around. It's been around since 1959 and I still prescribed it, I probably prescribed it three times today, you know, because there's no withdrawal, there's no addiction. Like it's a great cheap medication still. And it's a great adjunct to if we're using injectables too, so maybe we can use less medication on with the injectable. So there's not as many side effects. But the landscape has definitely changed. More and more people are wanting to get into obesity medicine. And in my, it's. 

12:11
Dr. Melody Rodarte
My fear is for the wrong reasons because they just want to be able to prescribe the medication, but they're not understanding the powerful tool they have and that they don't have to use high doses to have results. 

12:25
Dr. Jill Carnahan
Okay, I couldn't agree more. I can't wait to dive into that. What I want to do is first talk about, and I think you and I agree a lot of times these GLP ones, they work well and many physicians who don't really understand are just giving the brand name at higher doses. And I feel like you do that there may be a better place, especially for people who have, don't have a huge amount of weight loss, where it's being over prescribed or overused. And yet I feel like they're amazing drugs and so powerful when used. Right. Do you want to talk about the differences of safe use, not safe use, where maybe the landscape is headed? That may not be the best thing for these drugs. 

13:04
Dr. Melody Rodarte
Yeah, I mean it. We could spend more than an hour. 

13:08
Dr. Jill Carnahan
I know. And then we'll go. Just so you guys know, we're going to go into hormones and metabolic because I really want to talk about that. But for the moment. 

13:16
Dr. Melody Rodarte
Well, with these, the GLP1s and the combo, you know, GIP, GLP, which is the Tirzepatide there, it's incredible. And so many times we can start low dose and unfortunately the only pen that's adjustable is the Ozempic pen and that's specifically for diabetes. And I love that it was adjustable because then we could start super low and sometimes keep it low. With the others, the Wagovi Mongerno and Zepbound, it's a one dose pen and I think that's really where we got in so much trouble with it. They're now making it in vials so that it's a little bit easier. But I mean, let's talk, let's be honest here. I was doing it compounded for my patients for the last two to three years. I was being very specific on where I was obtaining it for my patients because I wanted it correctly done. 

14:11
Dr. Melody Rodarte
I didn't want to see cellulitis. I didn't want to see because of how it wasn't being manufactured properly. So the pharmacies I chose were very methodical on where they got the medication from and how they were preparing it for our patients. I loved about that is I could one micro dose it. So a lot of people say micro dosing, they don't understand it. Micro dosing are the smaller doses that are available. So let's say 0.25 on semaglutide is the typical starting dose but I can start it at.07, you know, 0075 or 0.01. That's microdosing. And so and we don't have to go up to the higher doses. If my patient came back and said I'm not hungry, I don't have food noise and I'm safely losing weight, why would I go up? 

15:03
Dr. Melody Rodarte
And then I also noticed they're less inflamed, they're not carrying around as much water intake and now we're seeing the literature even say that we can use this for anti inflammatory type of processes. 

15:16
Dr. Jill Carnahan
Hey guys, just a really quick 10 second interruption to let you know if you haven't yet got that book unexpected. You can get this@readunexpected.com Best selling Amazon. You can find it anywhere you get where books are sold and I promise you it's going to be an inspiring journey to check that out. You can find it@readunexpected.com or anywhere Books are sold. Okay, back to our show. I completely agree and I've been using that very frequently and what I see, I deal with a lot of mast cell activation and yeah, complex chronic illness. 

15:48
Dr. Jill Carnahan
And there is a clear, again this is my clinical experience but I think the literature will support this in time that there is a very clear anti inflammatory benefit in some of these patients that I mean some of the time in the very beginning they would even come back to me and be like, you know, yeah, the weight loss is great but here's what I noticed, right, My brain's better, my joints feel better, less pain, less inflammation. And then I started diving in and realizing just like you said, there's actually so much more benefit. And just like you, I want them on the lowest dose, the shortest time to have the effect and then that microdosing really works. 

16:22
Dr. Melody Rodarte
Well, yeah, I would love to do like I've invited anyone, I'm like one, I want to prove that my patients don't have sarcopenia, that they, you know, that I can even dose it out where Maybe it's every 10 to 14 days once we get to their goal. Like we just don't have the research to say that. But so many of us in this field are doing that. And then in the past I've been doing some past research too. There are a few papers that are published talking about reducing cytokines and inflammatory like our interleukins and our TN. So there is information even from the older generation GLPs that are out there showing the anti inflammatory response of this class of medications. So it's really interesting. I think the field, it's going to be wide open. 

17:11
Dr. Melody Rodarte
I mean, I don't know, is there like five or six more coming out in the next three to four years? 

17:15
Dr. Jill Carnahan
Yeah. You know, so good or bad, the fact that their pharmaceuticals are making so much money on that is leading to more research. I don't love that, you know, when they like take over the market and it's all about money. But in the other realm, for our sake as clinicians, I think we will have lots of good research on these other benefits, which is exciting. Now your thing is hormones too, you really understand. And obviously the HPA axis, the female and male hormones and the thyroid all have sideways much to do with. Do you want to give us a little primer? You could probably spend two hours but maybe just a little glimpse because like I said, most of my listeners, men and women, but the age range is kind of this time when the hormones do fluctuate. 

17:57
Dr. Jill Carnahan
How does that affect weight and what would people like to know more about? 

18:02
Dr. Melody Rodarte
I think most of us being in. When we enter into perimenopause, we don't like to hear, oh, it's just part of getting older, you know, you, it's a rite of passage. It's not. There are so many things that we can do. And I don't like when people, especially women, are pooed. As soon as a male's testosterone starts to drop, it's like which form of testosterone do you want? And with us as women, one, they're scared of hormones as we kind of opened up talking about. And two, they're not really understanding that we can start treating this perimenopausal state and replacing our hormones earlier than when we classically go through. No, you haven't had a period one year your menopause, now here's your patch, you know. And our metabolism does change. 

18:54
Dr. Melody Rodarte
That decrease in estrogen really makes a difference on how we place our, our how our visceral fat starts to get a little bigger. I mean what woman says I never had a pooch, now I have a pooch. You know, I'm not being able to. My endurance working out is not the same. I can't build muscle like before. And that, you know, we'll check their testosterone. It's literally zero. I love to tell women our ovaries and our adrenal glands produce testosterone like it's not a male hormone. It's also a female hormone. And you also brought up our thyroid. I think as we age, we're more likely and the conditions that we're living in, our thyroids are not working as well. And it is part of that. 

19:35
Dr. Melody Rodarte
It is when we balance the thyroid, sometimes, you know, our estrogen and our testosterone, all of those are a little bit better. You know, there's this balancing. So just to check one aspect is not enough. We really need to follow that HPA axis like you mentioned, and really dive into it. Because as we get healthier, let's say someone is having their glass of wine, they're eating lots of carbs, they're actually working out too much, and they're just fatigued. They might need more hormonal support until they start to change their lifestyle. And then we can kind of back down on some of that hormonal support because their ovaries wake up or they'll go, oh, I was going every three to four months. Now I'm back to monthly. Is that bad? I'm like, no, you're reversing the aging process. 

20:22
Dr. Jill Carnahan
I love that you mentioned that, because for me, when I hit 40, so I had cancer in my 20s, and so the chemo hit my ovaries, and then I had celiac and amenorrhea for. Well, and all that. Just to say that my poor ovaries, I'm so happy they made it to 40 because it's kind of a miracle with all that they got hit with way early in my life. And I think I hit menopause around 44 or 45. So a little early. But what I wanted to share, and I'd love your comment on this, is before that, before the age of 40, I was doing high intensity interval running at a pretty fast clip and really pushing myself, usually getting up in the morning, going to do an intense workout maybe five, six days a week. And I always carry just a little extra. 

21:01
Dr. Jill Carnahan
I mean, I was fine and healthy, right? But for me, I always felt like I had a little superficial weight, just maybe 5, 10 pounds. And when I hit 40 and actually stopped working out, I always joke about I got in the best shape of my life because as you mentioned, as you can totally see what was happening, right, I was driving that cortisol up. I was estrogen dominant. And so both of those things together, cortisol, way too much estrogen related to like zero progesterone, was just the perfect storm. And then when I started slowing down, walking, doing some weight training and doing a lot less high Intensity, cardio. I got in such better shape, lost, you know, five or ten pounds, and I've just stayed there, super healthy, strong. But then what happened is I met a trainer recently. 

21:45
Dr. Jill Carnahan
I've been working with him and now I'm running again, but I'm doing it totally different. I'm keeping my heart rate in zone 2. My body composition is best it's ever been. But it's so interesting. I love your comment because I think my experience may not be so different from the women out there where I was totally over exercising, especially with a stressful life. Right, right. 

22:03
Dr. Melody Rodarte
Yeah. I love that you brought it out, because mine. I love to say my ovaries gave me their all until about 45 or 40. 

22:11
Dr. Jill Carnahan
Like, we're done, we're out. 

22:13
Dr. Melody Rodarte
Yeah. And that was the same thing. My acupuncturist at the time, she looked at me and she's like, melody, you need to stop going to boot camp. I'm like. I looked at her like, you're crazy. 

22:24
Dr. Jill Carnahan
Exactly. 

22:25
Dr. Melody Rodarte
My stress relief. I Love it. My 5am group is my crew. And she's like, you have no reserve right now, and I'm telling you're not allowed to go. And I'm just like, you can't tell me that. But I'm so thankful that she did because I started yoga at that time and I started to train differently. And I've had this. I've had a trainer now for the last three years. I've never had this much muscle in my life, and I'm. And I have not returned to boot camp. I just do it. How I work out is completely different than five or six years ago. But. But I'm so thankful that someone had the gall to say it to me because I think a lot of times they don't want to tell us things. They're like, oh, she's a doctor, she'll get it. 

23:09
Dr. Melody Rodarte
But she's like, my. She was like, no, you are doing damage right now. And whenever, like, think about it, all of our patients, when I tell them that I need you to slow down, we're going to have to change your workout routine. They have that same, oh, my gosh, I'm going to gain all this weight. What are you telling me? You're taking away my lifeline. And I'm just like, give it three months. These are the things I want you to do. We're going to try yoga or Pilates or, like, just walking instead of running. And then it. 99 of the time they're coming back and, like, I didn't believe you, but I'm so glad I trusted you. 

23:45
Dr. Melody Rodarte
We, we've just, we're just used, especially our generation, we're used to like at the gym, pumping it as hard as possible and like you want to come home and crash on that couch and we didn't realize what we're doing to our dreams. 

23:58
Dr. Jill Carnahan
I so love that we have such similar stories because I think a lot of our listeners are professional women or women who have, you know, raised a family, do the work, you know, do all this thing just like you and I. And it's funny because medicine by nature kind of trains us that way. Right. You push too hard. It's very masculine driven kind of thing. And I love that we're having this discussion because I think the biggest thing, my biggest aha was I am a physician, I know like functional medicine. While I've been doing it 20 years, so are you and for us to not have that knowledge about over exercising and the cords, I mean we know the HPA axis, this wasn't anything foreign to us and yet I was doing it all wrong. 

24:36
Dr. Jill Carnahan
So first of all, that's just a big aha because I think if you and I as professionals who are in medicine didn't really understand that, how much more is the average person not getting that message? 

24:47
Dr. Melody Rodarte
Right? 

24:48
Dr. Jill Carnahan
So how do you frame if someone comes in and say they're, let's say it's a 45 year old woman, they're in perimenopause or menopause and they're struggling with an extra 20 or 30 pounds. And do you do it every person, individual? What would you do for a workup and then what would you recommend they do as far as their exercise routine and diet? 

25:07
Dr. Melody Rodarte
Yeah. So my consultation is a whole hour and they fill out probably six pages on their history before they see me. And then I decide on what lab panel to get because that into my, in my experience makes it a much better consultation and I can give a direction much easier. But I do, I like to know how many kids do they have? Are they already raising grandkids? You know, what is their work life balance. It makes such a difference to know that about them. What does their nutrition look like? And I do more than just a tsh. It's so important for them to know their whole thyroid panel and thyroid antibodies. Women especially are prone to Hashimoto's, which is, you know, autoimmune thyroid disease. 

25:52
Dr. Melody Rodarte
And a lot of times when we find out, I mean you have celiac, we understand that our diet can really affect how our thyroid functions. You know, and so I'll look at that. I'll look at not just an LH or an fsh. It's really important to get their estradiol level, their progesterone level, like their dhea. There's so many more hormones than just what in med school we were taught, you know, or when someone was thinking about conceiving. The only little tiny, you know, panel that we did, a morning cortisol can be very helpful. A morning insulin and A1C. So many people don't understand what their risk factor for insulin resistance is. So they probably. I love it. My. Most of my patients are like, oh, my gosh, I've never had six to eight vials, you know, removed at one time. 

26:41
Dr. Melody Rodarte
But I'm looking at the whole picture because that then lets us know what can we tackle? What are we going to tackle as far as your sleep, wake cycle, your exercise cycle, your stress reduction, what hormones do we need to replace? Maybe right now? What do we need to go on thyroid? You know, there's so many. If you're a pre diabetic, I don't wait till you're a diabetic. I. If you're showing insulin resistance, we're going to talk now. We're not going to wait, you know, until your A1C is at 6.5. That's. That's not fair that we are really teaching incorrectly on that. How about when the A1C is 5.4, 5.5, 5.6, we start having that discussion going. You're on the road for pre diabetes and diabetes right now. You know, cholesterol, our triglycerides tell us so much. Do an extended lipid panel. 

27:33
Dr. Melody Rodarte
It's more than just total cholesterol, triglycerides, HDL and ldl. Like, do you have genetic markers like your APOB or your lipoprotein A? Like, what's your crp? There's so many important labs, and that gives our patients, especially mine, I want them to have the tools that they can then follow and the numbers to follow to see how their body is responding to them getting healthier. 

28:00
Dr. Jill Carnahan
Oh, my goodness. You and I are just very similar in the approach. I think that's so powerful. And women and men want to. Do you see both men and women? 

28:09
Dr. Melody Rodarte
I do, and I love it. Because when the females do, usually they'll be like, I'm dragging my husband in here. 

28:15
Dr. Jill Carnahan
Exactly. Or even my son or daughter. It's like the Whole family comes once they find you. 

28:20
Dr. Melody Rodarte
I love it. 

28:21
Dr. Jill Carnahan
Oh, that's so great. Well, we'll finish on women, then we'll talk a little bit about men because that's an important thing, too. And I always find that in some ways that's simpler because there's less hormones to deal with, but they still benefit from all of these same exact things that you talked about, including estrogen. Right. For men, make sure it's not too high. So for the woman who, you know, metabolically is maybe pre diabetic, say they're A1C is 5.7 and their insulin's like, you know, 15. Fasting. Where would you start with someone who is metabolically out of shape and with the weight loss picture. Give me kind of just maybe the top three to five things that you would say. These are really key for when you want to reverse a pre diabetic. 

29:01
Dr. Melody Rodarte
Yeah. One would be reducing carbohydrates, simple carbohydrates, processed foods. If they're perimenopausal, I'm going to tell them not to fast right now. I'm going to tell them they to need. Need protein at least three times a day. And I'm with Dr. Lyon. I want 1 to 1.5 grams of protein per kilogram body weight. And maybe we just shoot for three times a day. But when they're in that state, I want a routine. I don't want fasting yet. When I see that they have reserve again, we'll talk about intermittent fasting. But I take them away from that. I also remove soda. That's not their friend. I remove alcohol for a while. They really cringe because I don't know why perimenopause and menopausal women love their alcohol, but I'm like, we're taking it away for a little bit. 

29:48
Dr. Melody Rodarte
There's empty calories and it really slows down your metabolism and it makes. It has poor sleep. That's another topic. I'll tell them, get a whoop. Get an aura ring. Watch what happens when you drink alcohol and everything. And so nutrition, I guess would be one, two would be if they want. If they're really interested. I still love berberine brain. And then depending on other risk factors or where their body fat percent might be, we might introduce a GLP one at this time because. And it might be more micro dosing at this. I'm still. If someone has that history of pcos or if, you know, there is a monetary constraint, I still love metformin. Metformin is incredible. If they, especially if, you know, they don't want to do maybe berberine at higher doses, therapeutic doses. So I start thinking about that and then sleep. 

30:48
Dr. Melody Rodarte
I want to really dive into their sleep routine because that's where restoration happens, that's where insulin and cortisol levels come down. So if they're not sleeping, whatever I do is not going to stick and we'll be banging our head against the wall. So I think those are my top three things that I really will dive into to. At first. 

31:09
Dr. Jill Carnahan
Love this and so practical. Agree 100%. Now let's shift to someone may or may not be metabolic. We've really covered that. But say we have this perimenopausal woman who's starting to have irregular cycles. Maybe she's gone three, four months at a time without a cycle. She's starting to have trouble sleeping, maybe a few hot flashes. Walk us through how the hormones might affect weight loss. And obviously you're checking numbers. So right now we're going based on not having the labs, which you would have, but maybe just someone's listening, saying, oh, you know, I'm 39 and having symptoms, or I'm 55 and having symptoms. What would you do if weight loss was a primary concern with hormones in that range? And you can give us a variety of situations. 

31:49
Dr. Melody Rodarte
Oh, yeah. So I, I might do, I might start off with just progesterone and testosterone because testosterone, as it gets converted, it'll actually help increase their estradiol. So, you know, while they're still cycling, we might really not talk about estradiol just yet. Unless they really, you know, are having horrible hot flashes and mood swings and, you know, really pushing into it. But I love starting with low dose progesterone, micronized progesterone, because we go back to one of those key topics of sleep. It really does help their sleep and their mood. We might cycle it, we might change it depending on if they're really PMSing still. So they might not stay on the same dose through the month. Month. And then I'm a fan of testosterone, I really am. Smaller doses, they don't need to be on higher doses. It saved me. 

32:35
Dr. Melody Rodarte
It was the first thing that I went on and it was amazing. And I love to share my story with my patients because they just look at me like, really? And I'm like, yeah. My endurance, my libido, my, like, I know it helped with shedding some of that belly that I was just like, what is this? It really helped. I Feel like my metabolism out. So, so I talk to them about probably progesterone and either testosterone or dhea. Some who don't, who are really nervous about testosterone at first, I'll put them on DHEA because again, if we kind of roll back, it's that precursor to that testosterone. So that's kind of usually where I will start with someone who's wanting to do hormone therapy. But again, their thyroid ties into this. Are they borderline? 

33:24
Dr. Melody Rodarte
So someone who is having those symptoms of hairline loss, dry skin, constipation, cold hands and cold feet. Classic thyroid, like classic. And there these are my women who are like, I want to put socks on when I go to sleep. I'm sitting on my hands and they'll have a TSH that still might be in range but optimal is probably 0.5 to 1.5 for a TSH free T3 if it's not above 3.4. I mean it's really not. They're struggling and when they have all those symptoms, we're going to go on a low dose thyroid like and guess what, I, and this is, goes to back what I talked about, that their thyroid might recover. They might not need it long term, but I'm going to support it until things are better. 

34:10
Dr. Melody Rodarte
So when their energy, their concentration, you know, they're starting to shed some of that weight, they're then they're able to make more changes in their lifestyle because they feel better, you know, so. 

34:21
Dr. Jill Carnahan
Oh goodness, I could not agree more. As always, this is, it's so good because I think women just need to hear that the testosterone so important. What I have realized, so obviously I had breast cancer at 25. So I was leery because of the false interpretation of data in my late 20s and 30s about hormones. And, and then of course we got the full story. But as a breast cancer survivor I've had a particular interest and you know, in the 1940s they used testosterone to treat breast cancer. And when I dove into the data and there's actually a new company coming out that is actually using, this is new research that will being published. They're using testosterone with aromatase to treat dcis. And the preliminary studies are phenomenal. And the reason is this actually blocks the estrogen receptor to some extent. 

35:08
Dr. Jill Carnahan
And I remember reading some of this. So when I first started having symptoms that was exactly what I did was progesterone and testosterone and found it so powerful. And again now I get to talk to patients about the power. And now again it's just phenomenal to me that it actually could be protective or preventative or even, as this data comes out, maybe helping to treat breast cancer. Now, again, don't go by my word. The research is coming out, but I really feel strongly that it's a powerful part of women's hormone replacement and optimal body composition, like you. And so love that you're talking about that. 

35:42
Dr. Melody Rodarte
I love that you brought that up, too. Because even my breast cancer survivors, I will call their oncologist and I will say, look, I'm not depending on. You know, we'll go through it. Is it ERPR positive? Is it genetic? But I'm always. I'm always like, the first thing. I'm like, can we do testosterone in low doses? I need to get their muscle mass back up. Like, I need to help with some of their symptoms. And I love that there are a few that have been on top of the research as well, that they're like, yes, and I will follow along with you because is they're more at risk for osteoporosis and sarcopenia and Alzheimer's and so much. 

36:18
Dr. Melody Rodarte
So if we can start with a little bit of testosterone therapy to give them back a little bit of their health, I get ecstatic and happy and just, like, want to do a flip for them. 

36:28
Dr. Jill Carnahan
Oh, I agree with you. And same exact conversations going, do you realize how safe this is at the appropriate doses and everything? Because like you said, when you have a patient who's been through cancer and they're sarcopenic and they're losing bone, they're at more risk of dying from a hip fracture. And so they're really like, as. I mean, we have to be very much of an advocate for them because these other things are so important. And sometimes. I know so many amazing oncologists, but there's a few that are so focused on this one marker of the cancer, and they're not thinking about the quality of life. I just think it's a tragedy for those patients. 

37:03
Dr. Melody Rodarte
I do too, especially when I get the ones. And I love my oncology friends. They. Their whole goal is help you survive. I mean, I know that when you're 25 and you're faced with that, you're like, just help me survive everything else. But once they have survived, it's like, how do we help them thrive? How do we keep them from having that fear anymore? Like, we need to stop having fear and helping them thrive. Because so many oncologists will be like, you just have to deal with the symptoms. For the rest of your life going to stay on this. And I'm like that. I have so many women who will tell me, I would rather have my brain than my breasts. 

37:40
Dr. Jill Carnahan
Yes, exactly. 

37:42
Dr. Melody Rodarte
I would rather take off five years if it meant I had better fight, you know, better five years where I wasn't dealing with all these side effects of the continued therapy. So I feel like in medicine, unfortunately we have lost the touch of having that conversation where we just look at a diagnosis and give a treatment and we're done. I want to go back to that old school where we have a conversation, we encourage the patient to make a decision with us and we talk through the risks and the benefits of each decision that we make. And we continue not say, I'll see you in a year, but we have adequate follow up so we can pivot every time we see each other if needed. Yeah. 

38:20
Dr. Jill Carnahan
Oh, I love that. So, so true. We have covered a lot. Is there anything else in relation to hormones and weight loss that you feel like maybe people need to know that we haven't really covered? 

38:33
Dr. Melody Rodarte
Yes. When you turn 65, stay on your hormones. Do not let them stop your hormones. 

38:39
Dr. Jill Carnahan
Oh, yes, yes. I'm like your biggest cheerleader, Dr. Melody, because everything you say, I'm like nodding and going, oh, my goodness. Amen. This is so great. I totally agree. It's interesting because I've worked with Dale Brezen who just deals with Alzheimer's and teaches really Recode and some of the doctors who treat that. I mean, he's starting women at 85 on estrogen because of the brain. And so, and again, there's controversy there as far as how you do it and watching it and receptors that, you know, what happens often is if we've never had hormones in our body, the receptors kind of shrink up. And so there's this whole mechanism there. But the truth is, for the brain, there is zero question about how much our brains need estrogen. 

39:16
Dr. Melody Rodarte
Yes. So yes, I totally agree. So I just wanted to get it out there because I know someone who's listening has been like they're going to take me off my hormones because I'm turning 65. I'm like, no, we can safely stay on it as long as we want. And I love. Because that storyline is changing too now, finally. But so many are going to practitioners who are still old school. So I wanted them to hear it here and know that they can continue safely on their hormone therapy. 

39:46
Dr. Jill Carnahan
Totally agree. And I'm sorry, so glad you said that. This has been one of the most power packed as far as just really good information for our listeners. And I'm so grateful and you just have such a beautiful joy and like you come across so lovely. I want to just give you a. 

40:01
Dr. Melody Rodarte
Big hug and I feel like we need to be friends now. 

40:04
Dr. Jill Carnahan
I know, right? Like let's go have coffee. But tell the people if they want to know more about your clinic, about what you're doing, any resources, where can people find more about you? 

40:14
Dr. Melody Rodarte
Yeah. So I'm in Arizona, in Gilbert, Arizona, a little suburb. My practice is called Activated Health and Wellness and we do see men too. So I think a lot of people don't know if we see men or not. And we are a cash pay concierge and that's because I want to do what's right for the patient and not what the insurance company is telling me. And I want to have a 30, 60 minute appointment with my patient, not a 10 minute appointment. So I have several providers who work with me and we do weight loss, we do hormone replacement, we do personalized medicine. 

40:50
Dr. Melody Rodarte
It's definitely my forte and I really, until the day I die, I want to continue doing this and just advocating one, for our fellow colleagues to teach them that there's so much more out there if they haven't done that extra the, you know, that extra training and two, for our patients to really seek out the care that they deserve because they do need to have practitioners, providers that are willing to listen and know that it's okay if you don't, if you're, you know, you can't fit in the box anyway. That can go on and on. 

41:25
Dr. Jill Carnahan
But I, yeah, I agree. But thank you for sharing and if you guys are listening, wherever you're listening and show, know that we'll have resources and links to Dr. Rodarte. But most of all just thank you my friend. It's been an absolute pleasure to interview today and thanks for the amazing work you're doing at helping to people to heal in menopause and beyond. Right. 

41:44
Dr. Melody Rodarte
Thank you. Thank you for all the work that you do. 

41:46
Dr. Jill Carnahan
Hey everybody, wasn't that a great interview? I just love her energy and I, I can see her as being next door and us having coffee. Such a sweet person and beautiful, brilliant physician. So I hope you enjoyed the interview. I hope it was practical. Please leave comments questions below. I come in, pop in and answer those and if you are not yet a subscriber on YouTube, join me with. I think we have over 600,000 subscribers at the time. This is recorded go ahead and click that. Click the bell to be notified of future episodes. And we will see you again next week on another episode of Resiliency Radio.